Provider Demographics
NPI:1073077368
Name:LARISSA K. RUUSKANEN, PSY.D., LLC
Entity Type:Organization
Organization Name:LARISSA K. RUUSKANEN, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUUSKANEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:540-412-8275
Mailing Address - Street 1:2217 PRINCESS ANNE ST STE 325
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3358
Mailing Address - Country:US
Mailing Address - Phone:540-412-8275
Mailing Address - Fax:888-972-2289
Practice Address - Street 1:2217 PRINCESS ANNE ST STE 325
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3358
Practice Address - Country:US
Practice Address - Phone:540-412-8275
Practice Address - Fax:888-972-2289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty